ANNEX A

17. You mentioned the Health Action Zones as a means of trying to target social need: can you please expand on how you expect them to address inequalities?[The Chairman]

1. The action plan will be launched in the next few weeks with the ethos of targeting deprivation through the collaboration of the public, private and voluntary sector. Two pilot schemes have been allocated £150,000 p.a. for three years with the aim of working with communities to find out what they see as important in making a difference to their well being. Key issues are seen as the number of under-15s and over-65s, and mapping systems are being devised to identify the most disadvantaged. Schemes such as 'Early Years Child Support' and the 'Southern Early Years Forum' evidence the commitment to childcare.

17. You mentioned cancer treatment in the context of the development of a regional/local partnership: are there any other areas that could be so developed? What are the key trends in Community Care? [Ms Hanna]

1. Two years ago a review of acute services was set up and we are still awaiting a decision. Planning for difficult change is not always possible - for example, if the Royal Colleges say that conditions of care are clinically unsafe, changes must take place immediately. The Board wants to work with the Assembly to plan any changes in the best interests of the population.

When funding for nursing homes transferred to HPSS in 1993 the Board quickly identified a gap in investment of about £20m and successfully argued for more resources; however, more funding is needed.

17. Many Community Carers are employed to do just a few hours each day and it is difficult to get extra care: is there any indication that more funding will be directed towards this area? [Mr Berry]

1. There is no indication that extra money will be available next year for the Community Care budget; indeed, there could well be further financial constraints. Domicillary care is therefore being closely targeted at those in greatest need.

17. There is a school of thought that NI is over-administered in terms of health care: what would the ramifications be of removing the Boards? Could the Trusts deal directly with the DHSS? [Mr McFarland]

1. The 'Fit for the Future' document in 1999 recognised that the whole system of the Boards, Trusts and GP Fundholders had to change, and that local voices should be listened to in tailoring services effectively. The Southern HSS Board feels that it provides good value for money, running on an overhead of 1.7%.

17. The increase in cancer cases is a concern: are there oncology services in all your hospitals? How many out-of-hours GP co-operatives have you, and are you satisfied with the cover provided? What do you see as the important equality issues? [Mr Gallagher]

1. The Board has been working with consultant surgeons and local people to tackle this issue sensitively and it now has the embryo of a good cancer service, especially breast cancer services, with a specialised oncology unit based at Craigavon. There is a shortage of consultant oncologists in NI and their centralisation in one site has meant a better quality of patient care with up to 50% more time available for patients in the absence of the consultants' previous lengthy journeys. Given the increased quality of the service, patients seem happy to make the extra journey to the regional site.

There are three out-of-hours GP services in the Board area, and they dealt very well with pressures over Christmas and the Millennium period, though lessons can of course be learnt. An extra 20 phone lines were installed in the co-operatives over the period, and although on December 27 some 1600 calls were taken (twice the highest ever), the average waiting time for callers was three minutes. The Moylin location is, however, accepted as not being ideal.

17. The promotion of health care is very important: how can we promote the dangers of smoking? Is smoking family-related? [Ms Armitage]

1. Getting across the message on smoking is an uphill struggle, as some statistics show, but an end to tobacco advertising would be most welcome. The message must reach social classes 4 and 5, where the high instances of smoking are a particular problem - people in these social classes are twice as likely to smoke as those better off, and the problem is increasing in women. Since 1981 the number of 16-to19-year olds smoking has risen from 18% to 30%. The Board is undertaking initiatives with the Ulster Cancer Foundation. There is clear evidence that smoking is family related. Statistics indicate that major problems are building up for twenty years hence in relation to cancer and heart disease.

17. You mentioned the launch of your action plan for Health Action Zones: can this be adapted for other areas? What do you see as the most neglected areas as a result of budgetary constraints? Do you have figures for bed blocking in your Board area over Christmas? How many Occupational Therapy (OT) assessments are outstanding in your area? [Mrs Robinson]

1. The Health Action Zones could be rolled out to other Board areas but the real benefit lies with having an integrated approach between the HPSS, the Housing Executive, the Health Councils and the Voluntary Sector to develop joint programmes on local issues.

Bed blocking was not a big problem for the Board during Christmas as it had set aside 18-20 beds in nursing homes to free up space as necessary. The Board worked closely with the Community and Acute Services Trusts to develop a common service and there was not a particular problem.

The Board has worked hard to tackle a backlog of OT assessments by examining the whole system, including the balance of staff. The outstanding figure fell by 50% in the first year but, because the HE has changed its working practices with regard to assessments, the numbers are rising again. The methodology for assessment is currently being discussed with the Department. The Board must work in partnership with the HE and local community but there equally must be an understanding of the limitations. The outstanding caseload is roughly broken as follows: one third waiting less than 3 months; a half waiting between 6 and 9 months; and the remainder waiting more than 9 months.

17. You mentioned the Department's proposal in 1998 to cut your budget by £6m: did that go ahead? Are there moves to redirect funds away from children's areas? What is the launch date for the Health Action Zones (HAZs)? Is there co-operation between the Board and its opposite numbers in the ROI in the border areas? Can the Committee have a copy of the Board's acute services review? [Ms Ramsey]

1. No, the proposed cut did not take place. The launch date for the HAZs is 11 February. The Board is not contemplating diverting resources away from children's services. It has recently invested £1.7m in this area and will continue to draw the Department's attention to this vulnerable sector, estimated as needing a £28m capital investment programme over the next five years. A new children's home has recently been opened in Newry.

There is close co-operation between the four Boards North and South in the border areas, and this has attracted £5m from European funds. Altnagelvin's catchment area includes East Donegal, and Daisy Hill's hinterland includes the Cooley Peninsula and North Louth. The Board is anxious that hospital services should reflect the flow of patients, however, it cannot provide a service gratis to patients from ROI.

The Board would be happy to provide Members with copies of the acute services review.

17. The withdrawal of services from South Tyrone Hospital was a real blow, and now there may be a problem with regard to the withdrawal of the cardiac ambulance service: does "temporary" for the Board mean "permanent"? [Mrs Carson]

1. The previous Minister decided on the withdrawal of services last July and the Board had to act in seven weeks to ensure an adequate, safe service was provided. The Board is determined that the community should get the best possible portfolio of services from the South Tyrone, and will work with the local council to develop this. The distinction is made though between listening to people's views and being able always to accommodate them.

17. The Board's recent report shows that we are not doing well in terms of physical measures: why is this? How do you intend to use the figures? Has the Board a strategic vision for the future? [Ms McWilliams]

1. The Board will first need to take stock of the data in the document and use it as a jumping off point, but there needs to be a clear link with targeting social need. We are planning a joint conference with colleagues in the SHSS Council to develop an action plan. Issues such as health promotion and prevention to which pitifully small resources are currently directed will be discussed.

Health and Social Services Minutes 26 January 2000